Cerebral Sinus Venous Thrombosis M.Petrova L.Grozdinski I.Petrov

CeRebral Sinus venous thrombosis /CSVT/ symptoms Introduction CeRebral Sinus venous thrombosis /CSVT/ symptoms Progressive headache Visual defects / blurred vision, diplopia etc./ Difficulty in speaking Seizures similar to epileptic Symptoms of stroke/ paresis of upper and lower limbs/

Anatomy of Cerebral Venous Sinuses

Risk Factors Heritable thrombophilia Chronic inflammation Pregnancy Oral contraceptives Autoimmune vascular diseases (lupus, Bechet disease)

Mortality rate Risk of death from a venous stroke 10-30% Often in younger age 20-30 y

Case Report CSVT patient History 44 year old female Venous stroke march 2013 No significant history of previous diseases Oral contraceptives – few years Smoker

PRESENT SYMPTOMS Dizziness Weakness in lower limbs “clumsy” right leg Headache Speech difficulties

Neurological Status Double vision on the left side Mild intention tremor with right hand Weakness in right leg Disturbed coordination- Romberg + Positive Babinski sign for right side Hypesthesia for right arm

MRT Phlebography Multiple hypo T1 and hyperintesive T2 and Flair lesions in the grey and white matter Watershed infarct Venous infarction as a result of thrombosis of the cerebral veins

MRT Phlebography Hypoplastic left jugular vein Hypoplasia and thrombosis of transversal venous sinus

MRT Phlebography Hypoplasia and thrombosis of the left transversal sinus

MRI Phlebography

EchoDoppler of jugular veins Chronic cerebro-spinal venous insufficiency (CCSVI) Hypoplastic left jugular vein Severe left side valve stenosis Moderate valve stenosis of the right jugular vein

left

right

Phlebography Hypoplastic jugular left jugular vein with severe stenosis Moderate stenosis of right jugular vein Severe stenosis of azygos vein

Balloon angioplasty of left and right jugular vein and azygos vein Endovascular therapy Balloon angioplasty of left and right jugular vein and azygos vein

Balloon Angioplasty of both jugular veins Before Therapy Balloon Angioplasty of both jugular veins Left IJV

After Left IJV

Before Right IJV

Right IJV

Before Azygos

After Azygos

Discussion We found CCSVI in patient with CSVT The patient has progressive neurological symptoms similar to multiple sclerosis /MS/ or other neurodegenerative disease We performed ednovascular therapy on CCSVI due to the obvious connection between cerebral venous pathology and the clinical symptoms Second case in our practice – combined pathology CSVT and CCSVI

Publications Keller, 2012 51 p with CSVT IJV stenosis /CCSVI/ in 61% of the patients 30 control patients with 0% CCSVI

Conclusions We found CCSVI in two patients with CSVT 2 hypothesis: 1. CCSVI of the IJV /hypoplasia, stenosis/ may lead to cerebral sinus thrombosis and venous stroke 2. CCSVI affects IJVs as well as the cerebral venous sinuses. This inherited anomaly may have a key role for development of neurodegenerative diseases or venous stroke